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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2018

01-10-2018 | Breast Oncology

Impact of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction

Authors: Catherine J. Sinnott, MD, Sarah M. Persing, MD, MPH, Mary Pronovost, MD, MSN, Christine Hodyl, DO, Daniel McConnell, Anke Ott Young, MD, PhD

Published in: Annals of Surgical Oncology | Issue 10/2018

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Abstract

Background

This study aimed to compare the impact of postmastectomy radiation therapy (PMRT) on outcomes after prepectoral versus subpectoral implant-based breast reconstruction with local deepithelialized dermal flap and acellular dermal matrix (ADM).

Methods

From 2010 to 2017, 274 patients (426 breasts) underwent prepectoral reconstruction. In this group, 241 patients (370 breasts) were not exposed to PMRT, whereas 45 patients (56 breasts) were exposed to PMRT. Of 100 patients (163 breasts) who underwent partial subpectoral reconstruction, 87 (140 breasts) were not exposed to PMRT, whereas 21 patients (23 breasts) were exposed. The outcomes were assessed by comparing complication rates between the pre- and subpectoral groups.

Results

A higher rate of capsular contracture was found for the prepectoral patients with PMRT than for those without PMRT (16.1 vs 3.5%; p = 0.0008) and for the subpectoral patients with PMRT than for those without PMRT (52.2 vs 2.9%; p = 0.0001). The contracture rate was three times higher for the subpectoral patients with PMRT than for the prepectoral patients with PMRT (52.2 vs 16.1%; p = 0.0018). In addition, 10 (83.3%) of 12 cases with capsular contracture in the subpectoral cohort that received PMRT were Baker grades 3 or 4 compared with only 2 (22.2%) of 9 cases of the prepectoral group with PMRT (p = 0.0092).

Conclusions

The patients undergoing subpectoral breast reconstruction who received PMRT had a capsular contracture rate three times greater with more severe contractures (Baker grade 3 or 4) than the patients receiving PMRT who underwent prepectoral breast reconstruction.
Literature
1.
2.
Vidya R, Iqbal FM. A guide to prepectoral breast reconstruction: a new dimension to implant-based breast reconstruction. Clin Breast Cancer. 2017;17:266–71.CrossRefPubMed
3.
Kobraei EM, Cauley R, Gadd M, Austen WG, Liao EC. Avoiding breast animation deformity with pectoralis-sparing subcutaneous direct-to-implant breast reconstruction. Plast Reconstr Glob Open. 2016;4:e708.CrossRef
4.
Bettinger LN, Waters LM, Reese SW, Kutner SE, Jacobs DI. Comparative study of prepectoral and subpectoral expander-based breast reconstruction and Clavien IIIb score outcomes. Plast Reconstr Surg Glob Open. 2017;5:e1433.CrossRefPubMedPubMedCentral
5.
Zhu L, Mohan AT, Abdelsattar JM, Wang Z, Vijayasekaren A, Hwang SM, et al. Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction. J Plast Reconstr Aesthetic Surg. 2016;69:e77–86.CrossRef
6.
Ricci JA, Epstein S, Momoh AO, Lin SJ, Singhal D, Lee BT. A meta-analysis of implant-based breast reconstruction and timing of adjuvant radiation therapy. J Surg Res. 2017;218:108–16.CrossRefPubMed
7.
Magill LJ, Robertson FP, Jell G, Mosahebi A, Keshtgar M. Determining the outcomes of postmastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: a systematic review and meta-analysis. J Plast Reconstr Aesthetic Surg. 2017;70:1329–35.CrossRef
8.
Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Ann Surg Oncol. 2017;24:38–51.CrossRefPubMed
9.
Downs RK, Hedges K. An alternative technique for immediate direct-to-implant breast reconstruction: a case series. Plast Reconstr Surg Glob Open. 2016;22;4:e821.CrossRef
10.
Bettinger LN, Waters LM, Reese SW, Kutner SE, Jacob DI. Comparative study of prepectoral and subpectoral expander-based breast reconstruction and Clavien IIIb score outcomes. Plast Reconstr Surg Glob Open. 2017;26;5:e1433.CrossRef
11.
Sigalove S, Maxwell GP, Sigalove NM, Storm-Dickerson TL, Pope N, Rice J, Gabriel A. Prepectoral implant-based breast reconstruction: rationale, inidications, and preliminary results. Plast Reconstr Surg. 2017;139:287–94.CrossRefPubMed
12.
Sbitany H. Prepectoral breast reconstruction: a safe alternative to submuscular prosthetic reconstruciton following nipple-sparing mastectomy. Plast Reconstr Surg. 2017;40:432–43.CrossRef
13.
Basu CB, Leong M, Hicks MJ. Acellular cadaveric dermis decreases the inflammatory response in capsular formation in reconstructive breast surgery. Plast Reconstr Surg. 2010;126:1842–7.CrossRefPubMed
14.
Cheng A, Lakhiani C, Saint-Cyr M. Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique. Plast Reconstr Surg. 2013;132:519–29.CrossRefPubMed
15.
Stump A, Holton LH III, Connor J, Harper JR, Slezak S, Silverman RP. The use of acellular dermal matrix to prevent capsule formation around implants in a primate model. Plast Reconstr Surg. 2009;124:82–91.CrossRefPubMed
16.
Lardi AM, Ho-Asjoe M, Junge K, Farhadi J (2017) Capsular contracture in implant-based breast reconstruction: the effect of porcine acellular dermal matrix. Gland Surg 6:49–56.CrossRefPubMedPubMedCentral
17.
Salzberg CA, Ashikari AY, Berry C, et al. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg. 2016;131:921–7.
18.
Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128:403e–10e.CrossRefPubMed
Metadata
Title
Impact of Postmastectomy Radiation Therapy in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction
Authors
Catherine J. Sinnott, MD
Sarah M. Persing, MD, MPH
Mary Pronovost, MD, MSN
Christine Hodyl, DO
Daniel McConnell
Anke Ott Young, MD, PhD
Publication date
01-10-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6602-7

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